Hospitalizations for Opioid Overuse and Abuse: Growing Impact on Medicare and Medicaid

Overuse and abuse of opioid drugs, particularly prescription pain killers, is a serious, costly problem, with a host of challenges for purchasers, payors, patients, physicians, pharmacists, regulators, public health, and drug manufacturers. For 20 years, overuse of opioid drugs has steadily increased, as have inpatient hospitalizations for opioid overdoses. Together, Medicaid and Medicare pay for two-thirds of inpatient stays for opioid overdoes. New statistics, highlighted here, paint a disturbing picture.

Trends in Hospitalizations for Opioid Overuse:

From 1993 and 2012, hospital stays involving opioid overuse among adults increased more than 150 percent. In 2012, there were 709,500 total opioid-related inpatient stays. Geographically and demographically, opioid overuse has evolved and become more egalitarian, as the problem has become a more widespread and universal public health problem:

In 1993, the national rate of inpatient stays involving opioid overuse among adults was 116.7 per 100,000 population, with notably higher rates among men, people aged 25–44 years, and people living in the Northeast.

However, since then opioid abuse by other groups – particularly, women, people aged 45-85+ years old, and people living in the Midwest – increased more rapidly.

Today, as indicated by hospitalizations, the rate of opioid overuse by men and women is comparable, opioid overuse by various age groups is increasingly similar, and the Northeast region is no longer the national outlier.

Impact of Opioid Abuse on Medicaid and Medicare:

In 1993, state Medicaid programs paid for about 43 percent of all hospital stays involving opioid overuse (opioid dependence, abuse, poisoning, and adverse effects). Since then Medicare’s share of all opioid-related inpatient admissions has grown rapidly.

From 1993-2012, opioid-related inpatient stays among seniors in Medicare (age groups 65-84 and age 85+) grew by an average annual rate of 9 percent. Overall, during that 20-year period, the rate of opioid-related stays paid by Medicare Part A grew faster than any other payor type – more than twice as fast as Medicaid.

As of 2012, Medicaid and Medicare each paid for about one third of all opioid-related hospital stays. By payor type, the number of opioid-related inpatient hospital stays in 2012:

Medicaid = 226,600

Medicare = 211,200

Private Insurance = 154,400

Uninsured = 82,100

Other = 33,700

Opioid-related hospitalizations among patients aged 45–64 has also been increasing rapidly – by about 8.9 percent annually. Given the significant increase in Medicaid enrollment among adults aged 18-64, Medicaid’s share of opioid-related inpatient stays will likely increase, with opioid abuse remaining an extraordinarily costly problem for state Medicaid agencies and Medicaid health plans.

Learn More in Statistical Brief:

These and other interesting data are from a new statistical brief from the Agency for Healthcare Research and Quality (AHRQ). The 14-page brief – Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993–2012 – provides a valuable (and troubling) portrait of adult inpatient hospitalizations involving overuse of opioids.

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The Piper Report blog on healthcare business and policy covers issues in Medicaid, Medicare, and the Affordable Care Act, with articles, interviews, resources, primers, book reviews, and more. Edited by Kip Piper, CEO of Medonomics.